title: Clinical features of cutaneous and disseminated cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis in Paraty, Rio de Janeiro.
abstract: BACKGROUND
  American tegumentary leishmaniasis (ATL) caused by Leishmania (Viannia) braziliensis is endemic in Rio de Janeiro State (RJ), where the disease shows epidemiologic and clinical characteristics distinct from those of ATL in other Brazilian regions. Paraty is the second most important endemic area in RJ; however, reports on leishmaniasis in this region refer to the occurrence of the disease without describing its characteristics.
  
  
  METHODS
  The clinical features of 71 cases of ATL reported between 1991 and 1997 in Paraty are presented. Thirty patients were re-evaluated 10 years later.
  
  
  RESULTS
  Males and females were affected in similar proportions, and the disease was more prevalent in patients aged between 10 and 49 years (63.4%). Cutaneous leishmaniasis was the most prevalent clinical form observed. Unique lesions were present in 69% of cases, 91.6% of which displayed an ulcerated aspect. Although mucosal leishmaniasis was not observed, severe clinical manifestations, such as disseminated cutaneous lesions caused by L. braziliensis, were diagnosed in two patients. These patients presented skin lesions with different clinical aspects spread throughout the body, as well as low cellular immune responses. Montenegro skin test (92% positivity) and serology (8% IgM and 56% IgG anti-Leishmania positive results) were the most utilized tests for supporting the diagnosis of leishmaniasis. Parasites, detected in 27 of the 33 cases analyzed, were characterized as L. braziliensis.
  
  
  CONCLUSIONS
  ATL in Paraty shares the clinical and laboratory characteristics reported for ATL in other regions of RJ, probably because of the similar epidemiologic context related to the Atlantic rainforest region.
authors.affiliation: Laboratório de Imunoparasitologia, Instituto Oswaldo Cruz/FIOCRUZ, Centro Integrado de Saúde, Secretaria Municipal de Saúde de Paraty, and Hospital dos Servidores do Estado, Ministério da Saúde, Rio de Janeiro, Brazil.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Vieira-Gonçalves
authors.forename: Claude
authors.initials: C
authors.lastname: Pirmez
authors.forename: Maria Eugenia
authors.initials: ME
authors.lastname: Jorge
authors.forename: Wilson Jacinto Silva
authors.initials: WJ
authors.lastname: Souza
authors.forename: Márcia Pereira
authors.initials: MP
authors.lastname: Oliveira
authors.forename: Marcio S
authors.initials: MS
authors.lastname: Rutowitsch
authors.forename: Alda Maria
authors.initials: AM
authors.lastname: Da-Cruz
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000818:Animals; D001938:Brazil / Q000453:epidemiology; D002648:Child; D015331:Cohort Studies; D019353:Endemic Diseases / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007892:Leishmania braziliensis / Q000302:isolation & purification*; D016773:Leishmaniasis, Cutaneous / Q000175:diagnosis* / Q000453:epidemiology*; D016774:Leishmaniasis, Diffuse Cutaneous / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D014505:Urban Population; D055815:Young Adult